ABSTRACT
Most of ingested foreign bodies passthrough the digestive tract spontaneously. The surgical care represents less than 1%. We report two cases of unexpected ingested foreign bodies treated surgically during the year 2019 in order to identify the surgical indications through a literaturereview. There were one woman and one man respectivelyaged 46 and 33. The accidentlyingestedforeign bodies werea denture and a toothbrush. An attempt to endoscopically extract the denture was unsuccessful. Peritonitis appeared as the complication in both cases. A radiography of unprepared abdomen showed the foreign body in the epigastic area, associated with a pneumoperitonitis in one case. Gastrostomy through laparotomy allowed to extract the foreign body without any complication. Surgery should be indicated either in complications or failure of endoscopic means to extractlocked foreign bodies.
La majorité des corps étrangers ingérés passent spontanément le long du tube digestif. Lerecours à la chirurgie représente moins de 1%.Nous rapportons deux cas de corps étrangers insolites ingérés et traités chirurgicalement au cours de l'année 2019afin d'en préciser les indications chirurgicales à travers une revue de la littérature.Il s'agissait d'une femme et d'un homme âgés respectivement de 46 et de 33 ans. Les corps étrangers accidentellement ingérésétaient un dentier et une brosse à dent.Une tentative d'extraction endoscopique du dentier a été pratiquée sans succès.L'évolutionétait marquée par la survenue d'une péritonite dans les deux cas. La radiographie de l'abdomen sans préparation (ASP) montraitle corps étranger dans l'aire épigastrique, associé à un pneumopéritoine dans un cas. Une gastrotomie par laparotomie a permis d'extraire le corps étranger avec des suites simples.La chirurgie doit être indiquée en cas de complications ou d'échec des moyens d'extraction endoscopique de corps étrangers enclavés.
ABSTRACT
This paper presents 4 cases of histologically verified peritoneal tuberculosis in HIV-infected patients followed in a 18 month-period. The patients were admitted in emergency and were suspected of present acute appendiceal peritonitis. There were 3 females of 18, 22 and 27 years old, and a 41-year-old male. The main symptoms were acute abdominal pain (4 cases), fever superior to 38 degrees C (4 cases) and abdominal defence (4 cases). Laboratory findings were hyperleucocytosis with lymphocytic predominance, anemia and CD4+ rate variable from 250 to 460/mm3. They underwent emergency laparotomy which led to diagnosis of peritoneal tuberculosis by histopathological analysis of peritoneal biopsies. Two patients died from surgery at days 3rd and 10th. The 2 remaining patients were successfully treated by tuberculostatic tritherapy with rifampicin, isoniazid, and pirazinamid. Acute peritoneal tuberculosis in HIV-infected patients is not to be missed in our practice. It must be considered in differential diagnosis of acute abdomens.
Subject(s)
HIV Infections/complications , Peritonitis, Tuberculous/etiology , Acute Disease , Adolescent , Adult , Cote d'Ivoire , Female , Humans , Male , Peritonitis, Tuberculous/diagnosisABSTRACT
AIM OF THE STUDY: The aim of this retrospective study was to specify the therapeutic strategy in the management of locally advanced rectal cancers in our practice in front of lack of radiotherapy. PATIENTS AND METHODS: This study had concerned 52 patients suffering from locally advanced rectal cancers, with mean age of 44 years old (range: 22-68). Evaluation for down staging was based on clinical, CT scan and intraoperative features. Patients were classified as T4NXM0. Thirty one patients (57,7%) had left iliac colostomy associated with a neoadjuvant chemotherapy, 12 had a left iliac palliative colostomy and 9 had chemotherapy only. RESULTS: Thirty two patients (80%) suffered from digestive toxicity due to chemotherapy, 11 patients had hematologic toxicity and 4 other had skin and mucous toxicity. Between the thirty one patients who had colostomy and chemotherapy, 4 (12,9%) responded well and underwent to curative rectal resection, in the remaining patients, the colostomy stayed palliative. The median survey time was 9,5 months. CONCLUSION: Our poor results confirmed the need of early detection and radiotherapy in the management of our patients.
Subject(s)
Rectal Neoplasms/drug therapy , Adult , Aged , Humans , Middle Aged , Neoplasm Staging , Rectal Neoplasms/pathology , Rectal Neoplasms/surgery , Retrospective Studies , Young AdultABSTRACT
AIM: To study the indications and evaluate the short term results of splenectomy for splenomegaly. PATIENTS AND METHODS: This retrospective analysis concerned 31 males and 21 feméles with a mean age of 30,5 yersin old, from February 1998 to December 2003. The aetiologies of splenomegaly were parasites (n=6), benign haematological diseases (n= 24), haematological malignancies (n=6), infections (n=3) and cysts (n=3). The indications were due to hypersplenism in 39 cases (79,5%), risk of splenic rupture in 46 cases (88,5%), infection or risk of infection in 3 cases and painful splenomegaly in 3 cases. 49 nine patients underwent complete splenectomy and the 3 remaining had a partial splenectomy. A spleno-renal shunt in three cases, mesenterico-adrenal shunt and mesenterico-cave shunt were associated for portal hypertension. A lengthy penicillinotherapy in all the patients and thromboembolic prevention in some were performed. RESULTS: The mean hospital stay was 6.3 days. Correction of cytopenia and permanent pain relief occurred in all cases. One patient died from intraoperative haemorrhage and 2 other from unknown cause postoperatively (09%). Morbidity was due to hyperthermy in 3 cases, abdominal haemorrhage by splenic vessel ligation leakage and bridles obstruction in one case. CONCLUSION: This study shows that hypersplenism constituted the mean indication of splenectomy. Its low mortality and morbidity suggest that it might be usually used in our practice. These results may be improve by laparoscopic splenectomy and systematic prevention of postoperative complications.
